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Utah and California Autism Treatment Center Named as Top National Behavioral Service Provider

Salt Lake City, UT (8/26/2016) – The Behavioral Health Center of Excellence (BHCOE) has awarded Alternative Behavior Strategies with an Award of Distinction, recognizing the organization as a top behavioral service provider in the country. The award celebrates exceptional special needs providers that excel in the areas of clinical quality, staff satisfaction, and qualifications and consumer satisfaction. These areas are measured via a wide-ranging audit, including interviews with agency clinical leadership, a detailed staff qualification review, an anonymous staff satisfaction survey, and an anonymous consumer satisfaction survey.

“Alternative Behavior Strategies is an organization that reflects standards of excellence across all aspects of services. This provider is committed to ensuring staff and caregiver satisfaction equally and utilizes best practices in Applied Behavior Analysis (ABA),” said Sara Gershfeld, Founder of BHCOE. “We are pleased to commend Clinical Director, Jeff Skibitsky, and his organization on creating an ethical program with an extensive scope of services that is invaluable to Salt Lake City and San Bernardino County autism community and beyond.”

BHCOEis a trusted source for recognizing top-performing behavioral health providers. Acting as a third-party, the organization systematically measures and reports on existing quality criteria in the behavior analysis community using standardized methods and practices, and awards only those service agencies that meet elite standards.

“At Alternative Behavior Strategies, we pride ourselves on the integrity and comprehensiveness of services, highly qualified staff, and active collaboration efforts to produce meaningful behavioral, social and academic results for our clients with developmental disabilities,” said Jeff Skibitsky, MA, BCBA, LBA, Founder of Alternative Behavior Strategies. “We are excited to be honored by BHCOE with this Award of Distinction and our dedicated team looks forward to providing individualized and ethical behavioral services throughout the Salt Lake City and San Bernardino area in the years to come.”

About Behavioral Health Center of Excellence (BHCOE)

The Behavioral Health Center of Excellence is a trusted source that recognizes top-performing behavioral health providers. BHCOE offers a third-party measurement system that differentiates top services providers from exceptional services providers. The BHCOE criterion features standards that subject-matter experts developed to measure state-of-the-art behavioral health services. The organization’s partnership with Love My Provider, an online review of services for families impacted by special needs, allows awardees to be featured as a Center of Excellence on LoveMyProvider.com. For more information, visit http://www.bhcoe.org/.

About Alternative Behavior Strategies

Alternative Behavior Strategies, Inc. (ABS) provides Autism therapy and related services, focusing on the use of Applied Behavior Analysis (ABA) to help ameliorate deficits and excesses attributable to Autism Spectrum Disorder or Social Emotional Disorders. ABS utilizes a variety of ABA techniques that incorporate motivation and function based teaching into the curriculum or family/community dynamic. These techniques vary from Verbal Behavior, Pivotal Response Training, Natural Environment Teaching and Positive Behavior Supports to more intense teaching methodologies such as Discrete Trail Training. Behavior change strategies focus on the development of alternative behaviors and establishment of skill sets that can replace maladaptive behavior. For more information, please visit http://www.alternativebehaviorstrategies.com/.

You’ve no doubt heard someone say ‘Patience is a virtue.’ But why is it a virtue? If you ask, a common response might be: “It helps us to get along with one another.” Well, yes; however, there’s another reason.

Sometimes we must make sudden decisions and take quick action. How can we get better, in that situation, at making a good decision and taking proper action especially when emotions are strong?

By being patient when an immediate reaction is not required.

In particular: “I think I should do …; however, it’s not essential to do that right now so I’ll be patient.” Several days later, perhaps, you reevaluate and conclude, “well, in fact, it will be better to …”. That patient consideration will help you in the future when you do have to respond immediately.

Children with Autism Spectrum Disorder as well as many other children with developmental delays experience a constellation of symptom that can affect many areas of development. The SLP’s (Speech-Language Pathologist) scope of practice includes evaluating and treating many of these areas, including: speech (articulation disorders, oral-musculature disorders, apraxia, stuttering), language (vocabulary, syntax, grammar), social-pragmatic skills (eye-contact, body spatial awareness, tone of voice), play skills (turn-taking, pretend play), eating/feeding skills, swallowing (dysphagia), reading (phonemic awareness), auditory processing, voice & cognitive skills.

Typical private speech-language services are often performed 1:1 in a clinic setting. In the school system, therapy is often performed in small groups within the classroom (push-in model) or in the speech room (pull-out model). Overall therapy time can range from 20 minutes to a couple of hours per week. While each of these therapy types is important, treating the wide range of needs for some of these children is challenging if not impossible. Since speech, language and social skills occur all day, every day, in various settings and with various people, forming a collaborative model with teachers, parents, aides and other therapists becomes essential.

Many children with Autism receive Applied Behavioral Analysis (ABA) therapy and/or attend a specialized classroom or school. These children will spend a significant amount of time each week working with their ABA team and attending school. Also, many of the goals of the ABA team, the school and the speech-language pathologist will overlap. Therefore, it makes sense that a collaborative model will give each child an extended period of time to work on their goals as well as to have the opportunity to generalize these goals into various settings and with various people.

The following are some examples of how a collaborative model would work:

Behavior Management

With ABA’s expertise in behavior analysis and behavior management techniques, the ABA staff can advise the SLP on types of rewards and consequences that work or don’t work for the child. For instance, the SLP is working on labeling actions in pictures with a child. Whenever this task is attempted, the child “tunes out” and/or tries to leave the table. After many hours of behavior analysis, ABA has found that all labeling tasks are difficult for this particular child and he greatly benefits from the use of a token economy system with a reward at the end. Now, the SLP has the tools she needs to keep the child engaged during labeling tasks.

Alternative-Augmentative Communication

Some children will need to use some form of augmentative or alternative communication system such as Picture Exchange Communication System (PECS) or an electronic system such as a tablet equipped with a communication app (i.e. Proloquo2go). The ultimate goal for the child would be that he/she is using their communication devices independently to communicate their wants and needs throughout the day. If the child were to only practice communicating with their device during speech-language sessions, the goal of truly learning the system and using it independently would be unlikely. Again, collaboration with the ABA team, parents & teachers would help shape what types of words & phrases will be needed for the device or the PECS system. The staff and family who spend the most time with the child will know best the types of things that are important to the child and the types of things that will help the child succeed at communicating with others. The SLPs knowledge of language development can help guide the team in choosing a realistic amount of vocabulary or sentence structures that would be most helpful.

Speech Production

For children who have speech disorders, it is often very difficult to understand the child when he or she is speaking. Some speech disorders can be as simple as misarticulating a sound or two. Other disorders could be muscle-based making speaking sound mumbled and imprecise. And still other speech disorders could be neurologically based such as apraxia, causing the child to speak infrequently and/or speak with unusual speech patterns/errors. These types of disorders will require direct therapy from the SLP in a 1:1 or small group setting. But the ability to learn to have clearer speech will take a significant amount of practice. This is where a collaborative model will be exceptionally helpful to the child’s growth. Speech exercise is much like physical exercise in that if you don’t engage in it consistently and with purpose, it’s unlikely that you’ll see change. Collaboration could include the SLP providing lists of sounds/words to practice (accompanied by pictures if needed) as well as techniques for eliciting sound production to parents and ABA staff so they can incorporate the needed repetition and practice into the child’s day. For teachers of a classroom, the SLP can consult with her and perhaps come up with a cuing system (such as a visual reminder on the board or a hand signal) that will remind the child to “use their clear talking” when it’s the child’s turn to speak aloud in class.

Auditory Processing

Children with processing difficulties often benefit from learning strategies that will help them “listen better” and “hold on to information”. Again, these types of strategies should be taught by a SLP during speech-language sessions. But the child is only going to truly benefit from these strategies if they can use them in school or social interactions. Collaboration with the school and having the teacher involved in helping the child with processing difficulties could really make a difference in whether or not the child will succeed in group settings. Ideas for collaboration for children with processing difficulties would include: having the child sit at the front of class, asking the teacher to use visuals aides and supports, using an amplification system if possible, recognizing signs that the child is “getting lost” and then asking the class if anyone would like clarification. Additionally, children with processing difficulties have great difficulty processing novel words within a lesson and being able to try to figure out how that new word is associated with the lesson. Asking a teacher to provide lesson plans ahead of time could help the SLP or parents go over the information and new vocabulary ahead of time so when the lesson is taught during class, the child can “keep up”.

On a personal note, I have worked in both the schools (typical K-8 programs, Montessori schools & specialized classrooms) as well as private practice where children were typically seen 1:1 in the clinic or in small social-development groups. These were all amazing opportunities where I’ve had the pleasure of consulting and collaborating in a variety of ways. The collaboration here at Alternative Behavior Strategies has been a whole new experience in working cooperatively with an ABA team. It is so helpful to sit down with a member of the ABA team and talk about the child’s needs and goals. It’s nice to brainstorm ideas with other professionals and come up with strategies that will help a child succeed. It provides great insight into what the child is like during his/her day. This collaboration helps me to understand the child better; to see what makes them happy or triggers their behaviors. This information enables me to plan therapy and visual supports to help the child become more successful. It’s been amazing to watch the growth of the children who have had their speech-language goals incorporated into their ABA programs. The consistent practice has truly made a difference in seeing progress!

It is 2016 and BIG things are happening at ABS already this year. We are fine-tuning departments in our UT Corporate Office, bringing in new BCBA’s, and updating our systems. This letter is intended to bring you up to speed with all of these changes.

Administrative Staff Updates:

We have added a few Administrators to our departments. You may call or email to contact the following departments:

Clinical Staff Updates:

Please welcome our newest BCBA’s!

Kristyn Peterson, M.Ed, BCBA, LBA

Consultant

Kristyn received her Master’s of Education in Curriculum and Instruction, with an emphasis in Applied Behavior Analysis from Arizona State University, which enabled her to become a Board Certified Behavior Analyst. Kristyn has worked with individuals with special needs for over eight years in a variety of capacities, and has been working in the field of applied behavior analysis since 2009. She has worked in a variety of capacities, including direct care, training behavioral interventionists, and directing ABA programs. Kristyn has extensive experience working with children and adolescents with severe problem behaviors, including self-injury, feeding issues, and aggression. She is excited to be a member of the ABS team, and to be able to provide the best services possible to the individuals she serves.

Will Johnson, M.Ed., BCBA

Consultant

Will received his Master’s of Education in Curriculum and Instruction: Applied Behavior Analysis from Arizona State University in 2014 and subsequently became a Board Certified Behavior Analyst. He has worked with individuals from a diverse range of populations and backgrounds, but has had the most experience working with children and teens on the Autism spectrum. He has had several years of experience working directly with individuals as well as in supervisory and parent education roles. He is excited to be a part of ABS’ tradition of providing excellent quality of care to all individuals served.

Lindsey earned a Bachelor of Arts in Elementary Education and a Bachelor of Science in Early Childhood Education with a Minor in Human and Family Development from Utah State University in 2008. She taught first grade for Davis School District for six years and started with ABS in 2014. Lindsey is now certified as a Registered Behavior Technician with the Behavior Analyst Certification Board and she is currently working on earning her BCaBA certification, with an eventual goal of earning a Masters degree and a BCBA certification. Lindsey loves working one-on-one with children and having the opportunity to focus on each individual’s strengths and needs.

Rayl Smith, BA, BCaBA

Junior Consultant

Rayl earned a BA in Comparative Sociology from the University of Puget Sound. He is currently enrolled in a special education master’s program and plans to complete the requirements to become a Board Certified Behavior Analyst. When he’s not fishing, skiing, climbing, or trail running, Rayl delights in utilizing his active nature to motivate the children with which he works.

System Updates:

We have recently upgraded our Payroll system by moving to Paylocity. This system offers an integrated app that allows employees to view paychecks, benefits and manage time off from a mobile device.

Each year we meet with each employee to go over progress and goals. This is a great time to collaborate with administrators about your career path at ABS. We want you to know that you are valued and appreciated for your hard work. We are doing everything possible to create a workplace that fosters advancement opportunities, rich training and individual support. When we work together we create “Behavior Alternatives to Open New Opportunities” for our clients and ourselves.

I remember being at dinner with some friends a few years ago. We were reminiscing about the early infancies of our children and how we celebrated the moment when our youngsters began sleeping through the night (or somewhere close). We joined in the discussion with the enthusiasm typical of mothers speaking to other mothers who’ve “been there”, but whose travail was somewhere in the past. That is, most of us did. One of my dear friends reacted to the conversation by putting her hands over her ears and joking that she “didn’t want to hear it”. Her two children had Autistic Spectrum Disorders and, into early elementary school, were not predictably sleeping through the night. While her reaction was impressively good-natured, the long-term struggle with something as basic as sleep had real-life, everyday ramifications for their family, and underneath her lightheartedness, it wasn’t a casual matter.

Practitioners and researchers who work with Autistic Spectrum Disorder have increasingly taken notice of the wide-spread and serious matter of sleep disruption in ASD children, teens, and adults. Sleep problems are very common in this population, with studies indicating difficulties in this area occurring for between 50 and 83% of ASD children, often extending into adolescence. More and more, as professionals are developing intervention priorities, improving sleep is at the top of the list. Sleep difficulties can take different forms including:

Problems with sleep latency (difficulty falling asleep)

Waking through the night; sometimes staying up for prolonged periods of time.

Early waking

Persistent need for co-sleeping

Poorer quality of sleep, such as restlessness

The reasons for the rate of sleep disruption in this population is an on-going question for researchers, but some likely causes include:

Possible abnormalities in brain systems that regulate sleep

Differences in hormones such as melatonin and other brain chemicals that affect sleep.

Poor sleep hygiene (the environment and routine that are provided to support sleep)

Behavioral issues such as difficulties setting and maintaining limits.

Medical issues such as epilepsy or gastroesophageal reflux that can disrupt sleep and are more common in children with ASD

Psychiatric issues such as anxiety and/or depression

Difficulties reading social cues: children with ASD may not “read” the signs that the family is getting ready for bed because they are not attending or interpreting the meaning of these behaviors.

It can be difficult, especially for new parents, to determine when a child has a problem with sleep that may require intervention, and those that fall in to the category of “typical” disruption. It may be helpful to use the following as a guideline for trying to determine whether normal variations in sleep have reached the level of a sleep disruption:

If it takes longer than 30 minutes from the end of the bedtime routine to get to sleep.

If a child is unable to get to sleep without the presence of another person.

Frequent night waking, particularly if he/she is not able to get back to sleep easily.

If a child/teen/adult isn’t getting enough sleep per night. Based on review of the research in the area, The National Sleep Foundation recently revised their sleep recommendations for specific age groups and now recommends the following ranges:

Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)

Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)

Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)

School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)

Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)

Younger adults (18-25): Sleep range is 7-9 hours (new age category)

Adults (26-64): Sleep range did not change and remains 7-9 hours

Older adults (65+): Sleep range is 7-8 hours (new age category)

We have all experienced the effects of the lack of good sleep on our daytime functioning, but these effects may have more profound implications for children with ASD. Research has shown that ASD children with sleep problems have lowered cognitive functions (particularly with verbal skills that typically require more effort and concentration on their part), have more difficulty with social skills and increased emotional distress, increased hyperactivity, and poorer motor control. These impairments in turn make it difficult for ASD children to benefit as much as they might from the schedule of interventions that often make up their day. Sleep problems in an individual child have implications for the entire family: studies indicate that the parents of autistic children sleep less, have poorer sleep quality, and wake up earlier than parents of non-autistic children.

I want to pause for a moment to acknowledge the obvious: Parents of children with ASD want their children to sleep well and in many cases have gone to great lengths and have made personal sacrifices to accommodate, let alone address, their child’s sleep difficulties. Sleep (along with eating and toileting) is behavior that parents can not directly control by physically manipulating or exerting their will on their child. There is a significant amount of stress involved in attempting to improve sleep, and parents need to feel supported rather than judged as they begin to make changes. I will be making some suggestions about how to support better sleep in the next few paragraphs, but acknowledge that sleep difficulties are rooted in problems with neurobehavioral regulation and, as such, are often challenging to alter.

While keeping this in mind, parents should know that there is encouraging evidence to support the idea that parental efforts at improving sleep can lead to very positive outcomes. Researchers at Vanderbilt University have been studying sleep disruption in children with ASD for over a decade and have found that educating and supporting parents in understanding sleep disruption was critical to improving sleep for their children, and that most families in the study were able to make long-term improvements with parent-implemented interventions (Malow, Adkins, Reynold, Weiss, Log, Fawkes, Katz, Goldman, Madduri, Hundley, & Clemons, Parent-Based Sleep Education for Children with Autism Spectrum Disorders, Journal of Autism and Developmental Disorders, 2014 Jan 44(1): 216-228).

The first step in addressing sleep problems is to discuss the issue with your child’s primary health care professional. This is an important step because your doctor can help rule out potential medical issues or determine whether a more specialized appointment is necessary (such as a sleep specialist, ENT, or a neurologist). Your primary care provider would also be the appropriate person to see in order to discuss whether medication or a supplement such as Melatonin would be a reasonable avenue to consider. Melatonin is a naturally occurring neurochemical that assists in regulating the sleep-wake cycle. Children with Autistic Spectrum Disorders have been found to have abnormal Melatonin levels, particularly at night. Over twenty clinical studies have shown a significant improvement in sleep length and sleep latency for ASD children who were given Melatonin before bedtime, even at relatively small doses (1-3 mg.). Negative side effects have been described as “minimal”, although experts note that long-term effects deserve further investigation. (Rossignol DA, Frye RE. Melatonin in Autism Spectrum Disorders, Current Issues in Clinical Pharmacology, 2014; 9(4):326-34). Medications used to treat other ASD symptoms can sometimes affect sleep regulations and sharing information about this dynamic will be important for your pediatrician or psychiatrist as they work with you to find an optimal regimen.

Regardless of the cause or nature of sleep disruption, there are environmental and behavioral mechanisms that can be put in place to support sleep. While the initial effort required to implement some of these strategies may seem overwhelming, often substantial change can be seen within a relatively short period of time (two weeks is a commonly reported time frame for seeing improved response). One of my preferred resources for sleep intervention is the “Tool Kit” offered without cost by Autism Speaks. A tool-kit is also available for teen and young-adults: (http://www.autismspeaks.org/docs/sciencedocs/atn/sleep-tool-kit.pdf). Their research-based suggestions focus on the following strategy for tackling sleep problems:

Provide a Comfortable Sleep Setting: Think SENSORY issues at this stage. Is the room too hot, too cold, too bright, too dark (a dim night light is usually optimal)? Pay attention to trying to keep the room and the surrounding environment quiet. Some children benefit from increased sensory input such as weighted blankets. Enlist the advise of your Occupational Therapist for suggestions about what alternations might best incorporate your child’s sensory profile.

Establish a Regular Bedtime Routine: A reasonable routine should be between 15-30 minutes before bedtime and followed primarily in your child’s bedroom (other than tasks that require the bathroom). The routine should be done in the same order each night. To the extent possible, it is important that all adults involved in putting the child to bed follow the same routine. The more consistently the routine is implemented, the more it will be useful in helping your child regulate to sleep.

Tips for ensuring a successful bedtime routine:

Consider the use of a visual schedule to help your child anticipate sleep. The Autism Speaks tool-kit has a variety of examples that can be modified depending on your child’s language abilities.

Choose activities that are calming (listening to music, rocking, reading a book, a massage) rather than those that are stimulating. For example, if bathing is a stimulating rather than a relaxing activity for your child, move this activity to a time earlier in the day.

Try as best as possible to keep bedtime and wake-time the same throughout the week.

Restrict the use of electronic equipment while a child is winding down at night as this can be emotionally and visually stimulating, and the light from the equipment may interfere with Melatonin production.

Try to create a “getting ready for sleep” environment across the household, including dimming lights, speaking in quieter tones, helping siblings and other family members understand the need to model self-regulation behaviors.

Teach your child to fall asleep alone: Many modern parents place some value on co-sleeping, which is not necessary wrong in itself. However, if a child is unable to get to sleep by him/herself they will not be able to independently get back to sleep after experiencing the normal periods of wake/sleep that occur throughout a night of sleep. One approach to teaching a child to sleep alone incorporates principles of graduated sleep training (e.g. increasing the distance between parent and child on a gradual basis as he/she learns to regulate to sleep). The Autism Speaks Toolkit also describes the use of a “Bedtime Pass” that helps to communicate rules and a system of reinforcement around staying in bed long enough to get to sleep.

Promote Daytime Behaviors: Regulate nap-times to end before 4:00 p.m. to ensure that a younger child is appropriately tired when bed-time rolls around. Avoid giving your child caffeine (watch the chocolate!) and sugar close to bedtime. Daytime exercise can make it easier to fall asleep and children who exercise tend to have deeper sleep. Children with a high need for sensory input may require more intense, “heavy” sensory-oriented activities throughout the day.

If you’d like to explore more detailed information about sleep in children with Autistic Spectrum Disorders, the following resources may be helpful:

In order to compete in the innovation economy, companies need employees who think differently. That’s why, in May 2013, SAP launched its Autism at Work program, which is aimed at recruiting and hiring adults on the autism spectrum. The program has been such a success, SAP is currently working to expand it, with the goal of having 1 percent of its total workforce — approximately 650 people — fall on the spectrum by 2020, says José Velasco, head of the Autism at Work program at SAP.

We have been attending local events to reach out to children and families in the community. We recently attended RUSD Special Needs Fair in Riverside, CA and ran into some of our new families! The area is heavily populated but the community is tightly knit and involved in services and programs. We have had a wonderful time getting to know people in this area!